Ch. 12 Dementia

D with Prakinson's: Muscle Rigidity

*Hypertonia* muscle stiffness -patients may complain of unusual stiffness and difficulty initiating movement

Early Signs of Dementia

-*Memory* deficit/failure is usually the *first* noticeable symptom -Gradually lose abilities of *problem-solving*, decision making, judgement, managing physical space, and communication -The patient will also exhibit rapid changes in *mood* and *personality* -Eventually patients with dementia will *NOT* be able to take care of themselves and require round-the-clock care

To qualify as dementia must have the following criteria:

-Insidious in onset -NOT caused by delirium, schizophrenia, or major depression -Acquired -Persistent -Affects several areas of mental function -Severe enough to interfere with work, social activities, and relationships with others

Dementia with Parkinson's Disease

-Parkinson's is associated with dementia or may *lead to* dementia -65% of people with Parkinson's may develop dementia symptoms as the disease progresses

10 Warning Symptoms of Alzheimers

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Functional Assessment Staging Test (FAST)

7 stage system based on the level of functioning and daily activities -provides a clear understanding of the progression of AD from start to finish -Categorizes stages 1-7f -Each stage has a well defined duration and set of cognitive and behavioral abilities affected -Focuses more on an individual's level of functioning and activities of daily living versus cognitive decline -A person may be at a different stage cognitively and functionally

Mini Mental State Examination (MMSE)

AKA Folstein test -Commonly used to screen for mental status and cognitive impairment -Administration: 5-10 minutes -30 point questionnaire test with 11 items: orientation to time and present location, immediate memory, attention, object naming, phrase repetition, comprehension of spoken instructions, writing sentences, and copying a geometric figure -Also used to estimate the severity of cognitive impairment

Mixed Dementia

Alzheimer's disease and vascular dementia occur at the *same time* -A combination of CVA's and Alzheimer's disease is common -Having a combination of CVA's and Alzheimer's disease is *more common* than having vascular dementia alone -Brains of up to 45% of patients with dementia have signs of both Alzheimer's disease and cerebrovascular disease -Decline may follow a pattern similar to either Alzheimer's disease or vascular dementia or a combination of the two -Suspecting mixed dementia whenever the patient has both: 1) Evidence of cerebrovasculat/cardiovascular disease 2) Dementia symptoms that get worse slowly

Global Deterioration Scale

Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS) (aka Reisberg Scale) -One of the most commonly used dementia staging scales -Measure the progression of AD -Divides the disease process into 7 stages based on the amount of cognitive decline

Dementia

a group of brain disorders that disturb and damage cognitive function, such as memory and executive functions, personality, mood and social functioning. -Dementia is *NOT* a normal part of ageing -All dementias reflect dysfunctions of the *cerebral cortex* or brain tissues -It is caused by a number of underlying medical conditions that can occur in both elderly and younger persons -Some disease processes damage the cortex directly, others disrupt subcortical areas that normally regulate the function of the cortex -Dementia is often a *permanent* and *progressive* disease

Frontotemporal Dementia

a group of progressice dementias that primarily affects an individual's *personality*, *behavior*, and *speech/language* Diseases include: -Frontotemporal Lobar Degeneration (including *Pick's* disease) -Primary Progressive Aphasia -Semantic Dementia (difficulties of *understanding* language) -Corticobasal Degeneration (a rare, progressive neurodegeneative disease involving the cerebral cortex and basal ganglia)

Clinical Dementia Rating (CDR)

a numeric scale used to qunatify the severity of symptoms of dementia -This is the most widely used staging system in research -Using a structured interview protocol assesses a patient's cognitive and functional performance in 6 areas: 1) memory 2) orientation 3) judgement & problem solving 4) community affairs 5) home & hobbies 6) personal care -Scores in each are combined to obtain a composite score ranging from 0 to 3

Granulovascular Degeneration

a pathologcal process -small fluid-filled cavities containing granular debris appear inside nerve cells -often affect the neurons in the hippocampus

Dementia with Pick's Disease

aka frontal lobe dementia -Rare disease -Progressive degenerative disease beginning in the cerebral cortex of the frontal lobe -The symptoms of the disease include: 1) Difficulty in speech and thinking, behavioral changes, impaired regulation of social conduct, over activity, wandering, and changes in personality

6. Problems with Abstract Thinking

balancing a checkbook may be disconcerting when the task is more complicated than usual

Dementia with Lewy Bodies

caused by build-up of proteins (names *Lewy Bodies*) within the brain. -They interrupt the normal functions of neurons by making it harder for them to communicate; leads to cell death -Overlaps clinically with Alzheimer's disease and Parkinson's disease; more associated with Parkinson's D. -Deposits can cause symptoms typical of Parkinson's disease such as *tremor* and *muscle rigidity*

Symptoms Similar to Alzheimer's D.

difficulty making new memories and remembering old memories -Becomes easily confused -Making odd or inappropriate decisions and actions

Neuropathologies from AD are Usually

equally distributed throughout the brain -temperoproparietal-occipital junctions, inferior temporal lobe, and hippocampus are most frequently affectes -*Atrophy* of the temporal lobe and parietal lobe are often observed -Disorientation in space and loss of language and memory. *motor cortex, sensory cortex, and occipital loves are usually spared*

8. Changes in Mood or Behavior

exhibit rapid mood swings (from calm to tears to anger) for no apparent reason

D with Prakinson's: Postural Instability

impaired balance

The Causes of Dementia

include various diseases and conditions, such as CVA, head injuries, drugs, and nutritional deficiencies. All forms of dementia result from damage to neurons and/or the loss of communication among them. Loss of connections between neurons responsible for *memory* and learning* -Dementia often occurs as the *primary symptom* of neurologic disease, such as Alzheimer's disease -Dementia can also occur as the *secondary symptom* of neurological disease. Vascular disease sometimes causes dementia or the late stages of extrapyramidal disease.

Huntington's Disease

inherited disease -Dementia is common and occurs in the late stages of the disease -Personality changes are typical. -Reasoning, memory, speech, and judgement can also be affected

Neuritic Plaques

made up of fragments of a protein called *amyloid beta*, mixed with a collection of additional proteins dying neurons, and bits and pieces of other neurons. -The neuritic plaques tend to concentrate in the cortex and subcortical regions of the brain

Frontotemporal Dementia Lesions

mainly affects different parts of the brain than are affected by other forms of dementia: frontal and temporal lobes -unlike most other forms of dementia memory is not affected in people with FTD until later in disease -Cause of FTD is unknown but some due to genetic mutation -Can affect both younger and older than 40 to 60 -2 main symptoms: 1) changes in personality 2) loss of the ability to express and understand language

Symptoms Similar to Parkinson's D.

moving slowly and shuffling or shaking as they walk -Walking or standing very stiffly, with arms and legs flexed -Having a blank expression

7. Misplace Things

my put things in inappropriate places, such as iron in the freezer or wristwatch in the sugar bowl

D with Prakinson's: Resting Tremor

often occur in the hands, fingers, forearms, foot mouth or chin -typically, tremors take place when the limbs are at rest as opposed to when they are in movement "pill rolling" of hands often a first sign

4. Disorientation of Time and Place

patient with AD could become lost on their own street, not knowing where they are, how they got there, or how to get back home

5. Poor/Impaired Judgement

patient with AD could forget entirely the child under their care OR may dress inappropriately, wearing several shirts or blouses

10. Loss of Initiative

patient with AD may become very passive and require cues and propting to become involved

3. Problems with Language

patients with AD may forget certain words or substitute inappropriate words, making the sentence incomprehensible

2. Difficulty Performing Familiar Tasks

patients with AD may prepare a meal and not only forget to serve it, but forget they made it

1. Memory Loss that Affects Job Skills

patients with demetia mat forget things more often and not remember them later than their peers.

Creutzfeldt-Jakob Disease

rare disease occurs most often in young and middle aged adults -Disease progresses rapidly and is fatal -Infectious agents call PRIONS invade and kill neurons leading to behavior changes and memory loss

Leukodystrophy

refers to a group of disorders characterized by progressive degeneration of the white matter of the brain -Leukodystrophies are cuase by imperfect growth or development of the myelin sheath

9. Changes in Personality

show drastic personality changes becoming extremely confused, suspicious, or fearful

D with Prakinson's: Bradykinesia

slowness in voluntary movement. This may lead to difficulty initiating walking, but when more severe can cause "freezing episodes" once walking has begun

Arizona Battery for Communication Disorders of Dementia (ABCD)

standardized measure for the comprehensive assessment and screening of dementia -14 subtests -Evaluate linguistic expression, linguistic comprehension, verbal episodic memory, viuo-spatial constructions, and mental status -The results are useful for differential diagnosis, developing treatment goals and care plans, monitoring patient's change over time, and discharge planning

The cause of Lewy Body protein buildup...

still unknown; not reversible; no known cure

Symptoms Relatively Unique to Lewy Body Dementia

symptoms become better or worse from moment to moment or hour to hour -*Hallucinations* (especially visual) and delusions -Becoming active and *violent* at night -Rapid eye movement sleep disorder

Vascular Demetia

symptoms vary depending on what part of the brain is affected and the *cause* of the vascular dementia -The most noticeable symptom is *memory loss* and DECLINE in the ability to organize thoughts or actions. -Other symptoms include *confusion* and *agitation*, difficulty solving problems, unsteady walking, difficulty finding words, urinary frequency, urgency or incontinence, mood problems or changes in personality -*SECOND* most common type of dementia after Alzheimers. -About 20% of all people with dementia have vascular dementia -Result of a stroke in which small areas of the brain are irreversibly damaged. Some of these strokes may occur without noticeable clinical symptoms. -Onset of dementia is often sudden. Symptoms depend upon area of brain affected, but often *memory* and other *cognitive functions*

Alzheimer's Disease

the *most common* SINGLE cause of dementia -According for about half of all cases -AD is at least partly hereditary (runs in families) -Abnormal protein deposits in the brain and destroys neurons that control memory and mental focus -Patients with AD also have lower-than-normal levels of *acetylcholine* -AD is not reversible and no known cure or slow the progression, but can provide some improvement in cognition and behaviors

Dementia with Lew Body Affects...

thinking, attention, and concentration *more than memory and language* -Leads to a decrease in cognitive ability, hallucinations, movement problems, and delusions -The medications to treat Alzheimer's disease may also benefit some people with Lewy Body disease

Neurofibrillary Tangles

threadlike structures normally found in the cell bodies dendrites and axons -Neurofibrillary tangles are abnormal collections of a protein called *"tau"* -Normal tau is required for healthy neurons -In AD, tau clumps together. As result, neurons fail to function normally and eventually die -The neurofibrils become twisted, tangled, contorted, and clumped together

Wernicke Korsakoff Syndrome

two stage disorder caused by a difficiency of thiamine -When levels of thiamine (vitamin B1) fall too low cells are unable to generate enough energy to function properly -*Wernicke encephalopathy* is the first acute phase and Korsakoff psychosis is the long lasting chronic stage -Most common cause is alcoholism

Language Difficulties in Patients with Dementia

word finding prominent symptoms -Syntactic knowledge was preserved -Discourses produced by dementia patients are confusing and incoherent -Decline in complexity and length of sentences -Often produce empty and irrelevant utterances, and the frequency of producing irrelevant utterances increases as the severity progresses